CHAPTER-3

Practical skills for pharmacists

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Listening and Empathic Responding

Listening to patients
• Is trying to understand their thoughts and feelings .
• It is crucial to effective communication.
• Will determine the accuracy with which you are able to decode the
message congruent with the speakers message
• Involves understanding both the content of the information being
provided and the feelings being conveyed

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Listening and Empathic Responding…….

Some communication habits can interfere with your ability to listen

well
For example:
 Trying to do two things at once
 Planning what you will say next
 Jumping to conclusions before a patient completes the message
 Focusing only on content, judging the person, faking interest
 Communicating in stereotyped ways

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Skills useful in effective listening

1.Summarizing
2.Paraphrasing
3.Empathic responding
1.SUMMARIZING
 it is necessary for you to try to summarize the critical pieces of information,
during counseling & interview to sum up your understanding of the whole
problem.
 It allows you to be sure you understood accurately all that the patient
conveyed.
 allows the patient to add new information that may have been forgotten
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Skills useful in effective listening cont….

2. PARAPHRASING
• When using this technique, you attempt to convey back to the patient the
essence of what he or she has just said.
• Put into your own words what you heard speaker say
“So you are saying that . . .”
examples of paraphrasing:
• Patient #1: I don’t know about my doctor. One time I go to him and he’s
as nice as he can be. The next time he’s so rude I swear I won’t go back
again.
• Pharmacist #1: He seems to be very inconsistent
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3.Empathic responding
• Empathy defined as the “sensitive ability and willingness to
understand the client’s thoughts, feelings, and struggles from the
client’s point of view. It means entering the private conceptual
world of the other.”
 Communicating to patients that you understand their feelings. It
is “reflection of feeling”
 Empathy conveys understanding in a caring, accepting & non
judgmental way
 You can convey your understanding verbally & non verbally.

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Skills useful in effective listening cont…..

 It helps patients come to trust you as someone who cares about their
welfare.
 It helps patients understand their own feelings more clearly.
 It facilitates the patient's own problem-solving ability
 The main difference between an empathic response and a paraphrase is
that empathy serves primarily as a reflection of the patient’s feelings
rather than focusing on the content of the communication.

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 Types of empathic responses cont…

There are different way of empathic respond

oJUDGING RESPONSE

Patients feeling must be accepted with out judging


We often judge another person’s feeling


ADVISING RESPONSE

Obviously, we must, as pharmacists, give patients advice on their medication regimens. That is part of our professional

responsibility. However, the advising role may not be appropriate in helping a patient deal with emotional or personal

problems

Sometimes besides expert advice pharmacists advice conditionally for quick solution.

“ d”
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 Types of empathic responses cont…

oPLACATING OR FALSELY REASSURING RESPONSE

• Telling a patient who is facing surgery “Don’t worry, I’m sure your
surgery will turn out just fine” may seem to be helpful, but is really
conveying in a subtle way that the person “shouldn’t” feel upset.

GENERALIZING RESPONSE

• by telling them “I’ve been through the same thing .” --- jump to
conclusion
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QUIZZING OR PROBING RESPONSE
• We feel comfortable asking patients questions
• Must know how to probe with out interrogating
• Must be careful to focus on feeling if patient has expressed feeling- don’t
go to content
o Distracting Response
• Change the subject when you don’t know what to do.
Understanding response
• Only in the response is there any indication that you truly understand the
basis of concern.
• convey understanding without judging

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Problems in Establishing Helping Relationships

• There are countless sources of problems in interpersonal

communication between pharmacists and patients. However, certain
pharmacist attitudes and behaviors are particularly damaging in
establishing helping relationships with patients.
• These include
 stereotyping
Depersonalizing &
 controlling behaviors

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Problems in Establishing Helping Relationships cont…

STEREOTYPING
• Communication problems may exist because of negative
stereotypes held by health care practitioners that affect the quality
of their communication.
• AIDS patient
• Non compliant patient
• illiterate patient
• dying patient
• “psychiatric”patient

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Problems in Establishing Helping Relationships cont…
DEPERSONALIZING…percieving the patients as a case or number.
• Communicating with third party instead of the patients.
• If an elderly person is accompanied by an adult child, for example, we
may direct the communication to the child and talk about the patient
rather than with the patient.
• We may focus all communication on “problems” and “cases.”
CONTROLLING
• unequal power in relationships between providers and patients and the
tendency of providers to adopt an “authoritarian” style of
communicating.
• Fostering a sense of control in patients is important in patient–
practitioner relationships
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 Assertiveness

• Assertiveness is the ability to express one`s feelings and assert one`s right
while respecting the feelings and rights of others.
• Assertive Behavior
 Direct expression of ideas, opinions & desires
 Communicate in atmosphere of trust
 Initiate communication in away that conveys respect & concern.
requires that you respect others as well as yourself.
• Passive Behavior
Avoid conflict at all costs
Will not say what he really thinks
Hides from people and waits for others to initiate conversation
They put the needs or wants of other people above their own.
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may see themselves as victims who are subjected to the manipulation
of others.
• Aggressive Behavior
Seeks to win in conflict situation by dominating and intimidating
others
Promotes his point of view
Indifferent or hostile to the feelings, thoughts or needs of others.
easily angered and have a low tolerance for frustration.
usually serves to escalate the anger and aggression

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• People respond passively or aggressively because they have irrational beliefs
that interfere with assertiveness. These beliefs involve:

1. Fear of rejection or anger from others and need for approval (everyone
should like me and approve of what I do),

2. Over-concern for the needs and rights of others (I should always try to help
others and be nice to them),

3. Belief that problems with assertiveness are due to unalterable personality

characteristics and are, therefore, unchangeable (this is just how I am), and

4. Perfectionist standards (I must be perfectly competent. If I am not, then I

am a failure. Others must also be perfectly competent and deserve to be
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Assertiveness Techniques
Providing feedback
Criteria for useful feedback include:
• Feedback focuses on a person’s behavior rather than personality.
• Feedback is descriptive rather than evaluative.
• Feedback focuses on your own reactions rather than the other person’s
intentions.

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• Feedback focuses on problem solving.
• Feedback is provided in a private setting.

Inviting feedback from others

• Improve our interpersonal communication skills.
• Assess patient satisfaction and invite feedback on your services.
• Identify areas of your professional practice that may need improvement
and promote better relationships with others.

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Setting limits
• You take responsibility for the decisions you make on how to spend
personal resources without feeling resentful toward others for making
requests.
• Does not mean that you stop saying “yes” to requests.
• May be particularly difficult if you believe that the other person must
agree that you have a good reason for saying “no.”

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Making requests
• Asking for what you want from others in a direct manner is also
necessary in healthy relationships.
• In equal relationships, making requests, including asking for help, is an
important part of honest communication.
• We must trust that others will be able to respond to our requests in an
assertive manner, including saying “no.”
• Thus, we must not overreact when someone turns down our request in an
assertive way.

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Being persistent
• One important aspect of being assertive is to be persistent in assuring
that your rights are respected.
• Often when you have set limits or said “no,” people will try to coax
you into changing your mind.
• If you continue to repeat your decision calmly, you can be assertive
without becoming aggressive.
• This response of calmly repeating your decision is often called the
“broken record” response .
• It will stop even the most manipulative person without assigning blame
or escalating the conflict.

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Reframing
• Frames are “cognitive shortcuts that people use to help make
sense of complex information” Reframing techniques include:
• Focus on developing effective communication around a set of
limited objectives.
•Examine the potential validity of the other person’s perspectives.
• Establish a common ground. Search for areas of agreement and
focus on desired outcomes with a long-term perspective.

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• Identify opportunities to explore solutions not yet pursued and
opportunities for compromises.
• Finally, identify differences that cannot be bridged and at the
same time explore conflict reduction actions that can still be
taken.
Ignoring provocations
• Interpersonal conflict may elicit various ways of trying to “win”
by attempting to humiliate or intimidate others.
• For example, patients who are angry or feeling helpless may lash
out with personal attacks.

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• Pharmacists who feel unfairly criticized may respond in an aggressive or
sarcastic manner.
• Interpersonal conflicts between health professionals are often marked by
struggles for power and autonomy (often called “turf battles”).
• Ignoring the critical comments of others and focusing exclusively on
solving underlying problems can do much to keep conflict from
escalating to the point that relationships are damaged.

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Responding to criticism
• For some of us, criticism is particularly devastating because we typically
hold two common irrational beliefs:
(1) that we must be loved or approved of by virtually everyone we know,
and
(2) that we must be completely competent in everything we do and never
make mistakes.
• Since such perfectionist standards are impossible to achieve, we are
constantly faced with feelings of failure or unworthiness.

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• The only way to counteract and to begin to cope reasonably with
criticism is to begin to challenge the underlying, irrational beliefs that
lead us to fear the disapproval of others.
• How do assertiveness problems relate to your ability to function more
effectively as a pharmacist? Let’s examine a few typical situations in
pharmacy practice and determine what might be the most assertive way
to respond in relationships with patients, physicians, employees and
employers

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 Assertiveness and Patients
• Perhaps the most important assertive skill in relating to patients is your
willingness to initiate communication.

• Certain activities distinguish passive pharmacists from assertive ones.

• some pharmacists seem to hide behind the counter

• give prescriptions to clerks to hand to patients,

• and generally avoid interaction with patients unless asked specific questions.

• are able to avoid the potential conflicts inherent in dealing with people and

• are able to hide their own feelings of insecurity and fears about being incompetent.

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• Assertive pharmacists
• come out from behind counters

• introduce themselves to patients

• provide information on medications

• and assess the patient’s use of medications and problems with therapy.

• Encourage patients to be more assertive in asking questions

• Help patients prepare for visits with health professionals and

• encouraging their active participation in consultations

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• A particularly difficult situation that you will face in pharmacy practice is
responding to an angry or critical patient.

• it is important to keep in mind that their feelings of hostility may be

greatly magnified by
• the life stresses they are experiencing.

• Their illness

• Their feeling of helpless and dependence on health professionals.

• Waiting in physician offices, and finally waiting for a prescription.

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• It is important, therefore, to keep in mind that some (do not assume
all) patient anger arises from frustrations about being ill, and not from
personal grievances against you.

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Assertiveness and Other Health Care Professionals

• When problems in patient medication therapies arise, consultations with physicians or

nurses are often required.

• If you need to speak directly with the prescribing physician, you will be most
effective if you are persistent with receptionists and nurses in your request.

• Messages transmitted through third parties may not be the most effective means
of communication.

• Such persistence might sound something like this:

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 Assertiveness and Employers
• When you are criticized, it is important to distinguish between (a) the truths people tell
you about your behavior, and (b) the judgments (the “wrong” or “bad” indictments) that
they attach to your behavior.

• The following are five responses that are helpful in various types of situations where
criticism is levied.

Getting useful feedback

• Uncovering the problem will provide you with specific feedback that may be useful to you
in improving your performance.
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• Therefore, before reacting to any problem that may be present, first be
certain that you understand the exact nature of the problem.

• If a patient says that people in your pharmacy don’t care about

customers, find out exactly what happened that was upsetting and led
to this conclusion.

• In order to know how to improve your service, you must have specific
feedback that points out what changes might be indicated.

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Agreeing with criticism

• If you consider the criticism you receive to be valid, the most

straightforward response is to acknowledge the mistake.

• In any case, avoid “Yes, but . . .” responses that try to excuse behavior but
lead to increased annoyance on the part of the other person.

• “Yes, I am late for work a lot, but the traffic is so bad” usually leads to an
escalation of the conflict (“You’ll just have to leave home earlier!”).

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• If you made a mistake or were wrong, acknowledge that.

• When you acknowledge mistakes and apologize for them, people have
difficulty maintaining their anger.

• However, if you continue to make the same mistakes, the apologies will
seem insincere and manipulative since you have not taken steps to
prevent the problem from reoccurring.

Disagreeing with criticism

• If you consider criticism unfair or unreasonable, it is important to state

your disagreement and tell why. 35
• For example, you came in late to work this morning and your boss is
fuming and he says, “You’re always late. Nobody around here cares
about the patients waiting to get prescriptions filled.”
• It is important to say to him: “You’re right, I was late this morning,
and for that I apologize. But it is not true that I am always late. I know
I was late one day last month but that is the only other time I can recall
being late in the two years I have worked here. And it is not true that I
do not care about our patients. I think the way I practice shows them
my concern.”
• Not speaking against something you consider to be a personal injustice
or untruth leads to feelings of resentment and a loss of self-esteem for
having kept quiet.

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Fogging

• Fogging involves acknowledging the truth or possible truths in what

people tell you about yourself while ignoring completely any judgments

they might have implied by what they said.

• Let us see how this might apply in a pharmacy situation.

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Delaying a response
• Give yourself time to think about the problem before responding.
• Few conflict situations call for an immediate response. If you are
too surprised or upset to think clearly about what you want to
say, then delay a response.
• Tell the person: “I want time to think about what you’ve told me,
and then I’d like to sit down with you and try to clear up this
problem.
• Could we discuss the situation this afternoon at the end of my
shift?”

06/02/2022 38
 CHAPTER 4

COLLABORATIVE WORKING RELATION SHIPS B/N

PHARMACISTS & OTHER HEALTH PROFESSIONALS
Course objectives/Learning Outcomes:

 effectively communicate with patients, fellow pharmacists and

other health professionals
 INTERPROFESSIONAL COMMUNICATIONS

• Why Learning about interprofessional communication is

important for pharmacists?
 Because pharmacists role is shifted from traditional
product oriented to patient oriented service.
Today’s Pharmacists are
Competes on expertise……………not on products!
Product Oriented Patient Oriented
Today’s Pharmacist
Product Oriented Patient Oriented
 Product knowledge -  Patient-centered
factual basis therapeutics knowledge

 Legal guardian/Dispenser  Manager/Coordinator of

of drug supply drug therapy processes

 Professionally isolated  Collaborative, Team-

oriented practice; system
involved performance
DEFINITION OF TERMS
Collaboration

• “working together with one or more members of the health

care team who each make a unique contribution to achieving
a common goal.
• Collaboration involves coordination of individual actions,
cooperation in planning and working together, and sharing of
goals, planning, problem-solving, decision-making, and
responsibility.
 What is Interprofessional Collaboration

• Interprofessional collaboration can also be termed

Interdisciplinary Collaboration.
• Interprofessional collaboration occurs when two or more
individuals from different professions come together to reach the
needs of a client.
 What is team?

A collection of individuals who:

• are interdependent in their tasks
• share responsibilities for outcomes

47
MENTION THE NAMES/ TYPES OF
HEALTH PROFESSION THAT INVOLVED
IN THE HEALTH CARE TEAM?
• Pharmacy • Dentistry
• Medicine • Environmental
• Nurse health officer.
• Health officer • Occupational health
• Midwifery officer
• Laboratory • Optometry
• Radiology • ……………………
…etc.
• Physiotherapy
• Anesthesia
• Effective teams are characterized by trust, respect, and
collaboration.
• majorly two types of team work model in the health
care.
Interdisciplinary team
Multidisciplinary team
Multidisciplinary team
• in which each team member is responsible only for
the activities related to his or her own discipline and
formulates separate goals for the patient .
Interdisciplinary team
• coalesces a joint effort on behalf of the patient with a
common goal from all disciplines involved in the care
plan.
 Why collaboration is needed among these
professionals?

• No single discipline or specialty can meet all of a patients needs.

• With out communication among all of these professionals,

comprehensive & efficient treatment of the patient is not
possible.
• E.g.

a Hospitalized patient may need

A physician -to provide a diagnosis & treatment plan
A pharmacist- for regular medication review & mgt

A nurse -to administer medication, to help with bathing & toilet

Laboratory – to take blood samples

Physiotherapist – to aid in muscle strengthening & flexibility.
• What are the role of clinical pharmacists in the
health care team?
• Pharmacists led medication management ( Monitoring drug therapy &
Patient adherence )
• Lead the drug supply management system of the health institution
• Counseling & patient education
• Consulting & educating physicians & other health professionals
• Providing drug information
• Medication review & involving in influencing prescribing
pattern…………………………..
– Ordering drug therapy-related lab tests

– Selecting, initiating, monitoring, and adjusting drug regimens

 Pharmacists led medication management team

• Their role is expanded in the mgt of chronic diseases

HTN- pharmacists achieved significantly
Lower systolic & diastolic BP
Higher proportion of patient with good BP
DM_ Pharmacists led medication mgt displayed
Improvement in glycemic control& weight control
Pharmacists review of prescription for elderly patient improved quality of
patient care in regards to appropriate medication use by catching
possible interaction, allergy, c/I, & over medication.
 Involved in DSM
• The core functions of procurement, distribution/dispensing,
safe and secure handling of medicines remain intact.
• ------ better use of drugs
• ------- cost effectiveness
• --------promote RDU
These role of pharmacist requires full- cooperation of all health
professionals.
 Role of pharmacist in identifying medication related problems

• Research conducted in USA shows

 174 prescription reviews performed, only 3 resulted in no
changes.
 6% of hospital admission are associated with ADR

• in Australia
 An average of 1 changes were made per 5 patient.
 Education

• Inter professional/ multi professional education will be key to

improve the effectiveness of patient care.
• Pharmacists provide updated drug information to the patient,
public, & other health professionals.
Role of pharmacist in prescribing/ influencing prescribing?

• Now a days most medication related interventions made by pharmacists

are made retrospectively. And it is argued that pharmacist prescribing
could shift these intervention forward within pharmaceutical care plan so
as to optimize the use of drugs
What do you think , who is perfect to be a prescriber?

pharmacists/ physicians
• Effective & safe prescribing requires
 knowledge of pharmacology
 knowledge of dose, dosage regimen
 Drug- Drug interaction, drug- diet interaction
 ADR & drug monitoring
 Arguably pharmacists acquire much greater levels of expertise
in these areas in the course of their training than other health
care professionals including Doctors.
However, Pharmacists prescribing is not yet allowed in many
countries.
Perfect health system
• What is the advantage of collaboration?
Advantages of collaboration
Improved health outcomes

Reduced mortality

Fewer clinic visits and hospital stays

Reduction in medical errors through better communication

Higher levels of satisfaction with care outcomes

Enhance consumer safety

Increased job satisfaction

Reducing workload issues that cause burnout of staff

Increased staff motivation

Greater collaborative decision making with health professionals

Reduced costs

Etc…..
• What are the barriers / obstacles in pharmacist-
other health professional collaboration?
Personal values and expectations

 Power struggles

Most health professionals including pharmacist perceived that ultimate

authority is giving to doctors to take professional responsibility for patients .

( Power issue )
• Lack of trust in another practitioners competence

Lack of educational programs that encourage health professionals to work collaboratively,

Physicians being un aware of the training and activities of pharmacists.

(New role for pharmacists has been met with some resistance – mainly from older
physicians.)

Lack of respect

Lack of communication technology to allow partners to easily communicate with each other.

Government led policy/ legislation
 Finally

What will you do if the prescriber says no to your recommendations/suggestions?

– Be polite, Use the right words
– Be assertive but not aggressive
– Do not imply blame, but keep patient-focused
– Keep the communication channels open
– Explain the situation to the patient in a way that does not
undermine the physician-patient relationship
– Remember: reasonable people can disagree about
pharmacotherapeutic choices
 Ask Your Pharmacist!
S/He is expert of Medicine
 Chapter -5
Conflict management
Introduction
As pharmacists collaborate with physicians, nurses, patients, and others

on a more frequent basis, the possibility of interpersonal conflicts

developing increases.
Consequently, understanding the nature of conflict in pharmacy practice

and providing pharmacists with skills for managing interpersonal conflict

are important from a quality of working life perspective,
Learning Objectives

 When you complete this session you will be able to:

 Define “conflict”

Identify common causes of conflict

Identify the types of conflict

Use productive strategies to resolve conflict

 
What is Conflict?

Conflict is the expression of disagreement over something

important.
Conflict can be defined as an incongruity of desires, goals or values

between individuals or groups,

a clash of desires, values, interests, attitudes, manners and methods

usually spark a conflict.

Conflict occurs when our needs are unbalanced with others.

Arises from a clash of perceptions, goals or values in areas where

people care about the out come.

Conflict occurs when individuals or groups have competing interests

and ideas. These conflicts can arise for a number of reasons. Some
reasons are easily seen, while others may be more difficult to recognize
initially because they are based on different perceptions, emotions, or
beliefs that are not apparent.
Health care work place is a fertile breeding ground for conflicts

because of the dynamics & interdependency of the various

relationships that exist between & among care providers &patients.
There is a conflict b/n
Pharmacist- patient
Pharmacist-caregiver
Pharmacist-other health professionals
Pharmacist- pharmacist
IS CONFLICT BAD?
IS CONFLICT BAD?

 conflict is not always a bad thing. healthy disagreements can foster

creativity. 
Conflict is commonly perceived as being a negative issue.

 Conflict that is managed effectively by Pharmacists can lead to personal and

organizational growth

If conflict is not managed effectively, it can hinder a Pharmacists ability to

provide quality client care and escalate into violence and abuse.
• Well managed conflicts -advantageous
• Productive
Improved Relationships
Improved communication
Efficient problem solving
High productivity
A sense of achievement
Team cohesion
Stimulate competition
S.M.Israr
Poorly managed conflicts
Unfavorable with counter productive results
(Poor quality, lowers productivity)
Is characterized by frequent, repetitive arguments that are not
resolved.
Explosive, angry, hurtful, and resentful reactions
The expectation of bad outcomes
The fear and avoidance of conflict / Keeps people apart; if unresolved
Ill health
Time consuming
Characteristics of conflict
Conflict is
Inevitable- a normal, inescapable part of life & (unavoidable)

Not always bad in communication

it is a healthy sign not a negative process.

Necessary

Useful
 Generally ….
Conflict is… Conflict is not…
• Perceived difference • Sign of a bad relationship
– needs, values and goals • Negative experience
• Part of a relationship • Mistake
• Consequence of • Struggle between right
– growth and wrong
– change
Causes of conflicts
 Communication barriers
Difference in personality & Behaviors
Low trust/ lack of competences
Scares resource
Lack of job satisfaction, role description
Disagreement on recommended treatment plan and treatment
change.
Ethical conflict.
 How to prevent conflicts

Sharing objectives & goals

Making the communication open
Frequent meeting of your team
Having a clear and detailed job description
Distributing task fairly
Assess positive and negative personality traits of people
involved
Determine personality type Aggressive,passive,Assertive
Review past conflicts
 Types of Conflict

Intrapersonal Interpersonal

Intragroup Intergroup
Interpersonal Conflict
– Conflict between individuals due to differences in
their goals or values.
Intrapersonal conflict
Occurs within an individual
 Types of Conflict

• Intergroup Conflict
– Conflict between two or more teams, groups or departments.

• Intragroup Conflict
– Conflict within a group or team.

• Interorganizational Conflict
– Conflict that arises across organizations.

17-90
STRATEGIES- CONFLICT MANAGEMENT
Conflict Management

The use of strategies and tactics to move parties toward resolution or

at least containment of a dispute that avoids further escalation and

relationship destruction.
Managing conflict means you need to develop several styles and

decide which is valuable at any given point of conflict

 5 ways to manage conflict
• Avoidance(withdrawing)
• Competition (forcing)
• Accommodation (smoothing)
• Compromise
• Collaboration (win-win)

93
 Conflict Table
I win I
lose
You win Win-Win Lose-Win

You lose Win-Lose Lose-Lose

Avoidance(withdrawing)
two parties try to ignore the problem and do nothing to resolve

the disagreement
Not satisfies their own and others concern

avoiding strategy orients toward neglecting conflict

 LOSE-LOSE
 Competition(forcing)
• Each party tries to maximize its own gain and has little interest in

understanding the other’s position.

• Satisfies their own concern not others concern.

• Competing strategy is based on gaining or aggrandizing power and

authority
WIN- LOSE situation
 Accommodation(smoothing)
• one party simply gives in to the other party.

• Satisfies other concern not their own concern.

• Overlook own concerns to satisfy those concerns of others. It is a

form of selfless generosity that followed by yielding to

others’ wishes when one would prefer not to do.
• Win –win situation

97
 Compromise
• each party is concerned about their goal accomplishment and is willing

to engage in give-and-take exchange to reach a reasonable solution.

• compromising strategy seeks for sharing.

• Partially satisfies their own concern and partially satisfies other concern.

• Lose- lose situation

 Collaboration
• Parties try to handle the conflict without making concessions by coming up

with a new way to resolve their differences that leaves them both better off.
• Satisfies both parties concern

• Win-win

99
Generally
Communication is at the heart of both conflict & conflict management.
Poor Communication gets us in to conflict\
Effective & open communication able to resolve situation.
Self test: Matching
1.Inter personal conflict A. Within an individual
2. Intra personal conflict B. Between two individuals
3. Inter group conflict C. Within a team of individuals
4. Intra group conflict D.Between two or more teams
within an organization
Match
1. Competition A. win-win situation
2. Accommodation B. lose-lose situation
3. Avoidance C . win-lose situation
4. Compromise
5. Collaboration
 CHAPTER-6
 

Written Communication Skills

WRITTEN COMMUNICATION SKILLS
 
• What is written communication?
Definition:
• The means through which people exchange information, ideas,
thought, feelings & the like, with each other by the use of
symbols, words, pictures, figures & etc
• Prescription ??
.
 Prescription ??

 is serving as a means of communication among the prescriber,

dispenser and drug consumer pertaining to treatment or
prophylaxis.
• All written communications should be professional, accurate,
complete, and effective in getting across the intended message.
 Written communication skill is needed

 Note taking & documentation practices

 Developing patient education materials, news letters, etc

 Preparing a patient case presentation

 Preparing a journal club presentation

 Note taking & documentation practices

• Documentation is anything written or printed Relied on as a

record of proof for authorized persons

• Vital part of professional practice

• “If you didn’t document it, you didn’t do it,”

Who Writes Medical Documents?
Who Writes Medical Documents?

• All registered health professionals

• Pharmacists have experience maintaining prescription records,
but many lack experience documenting patient care activities.
• More comprehensive documentation practices are essential
when pharmacists implement patient care services, including
medication therapy management (MTM).
• The documentation of medication history has historically been
undertaken mainly by physicians and sometimes nurses.
• But the medication history information documented by physicians
are often
 in accurate,
 incomplete;
 and lack information regarding medication allergies, past
prescription / nonprescription medications and patients’ adherence
to prescribed doses.
• The participation of pharmacists in the documentation of
medication history has been shown to result in significant
improvement in its accuracy and comprehensiveness.
• Pharmacists acquired medication histories are often free of
error of commission, omission and more frequently document
past prescription / OTC medicines, allergy history and use of
alcohol
Types of written communication & documentation

• Case presentation • Medication history

• Drug formury • Medication information
• Pamphlet, ( flyer, letters
brochure) • Non prescription medication
• Instruction response to information
patient/ physicians • Drug return report
• Package label • Drug dispensing report
• Medication error report • Pharmaceutical care plan
• Discuss the Importance of Medical Documentation?
Documentation can fulfill several purposes, including:
• Improving patient care and outcomes.

Providing patients with information about their care. ---Enhancing

continuity of care.
• Protecting against professional liability.
• Allowing analysis of patient outcome data to assess the value of the
service delivered and communicates this information to others.
• Proper and adequate medical documentation is essential for
quality of medical care and health care services throughout the
industry, from receiving proper and correct treatment . & it
increase patient care.
• the records serve as
-a method of communication from one health professional, or
group of health professionals, to another.
-Patient records may also be used for research purposes, as
educational tools and
-as documentary evidence in legal proceedings
 Documentation Formats
 
• SOAP notes are widely used in the health care field to document
patient care.

• What is SOAP?
SOAP Format

Subjective
Objective
Assessment
Plan
 Subjective

Information the pt tells you about him/herself

(info reported by the pt or care giver)
Includes:
• ID & Chief Complaint (CC) …46yo M presents to pharmacy for
hypertension
• History of Present Illness (HPI) …pt reports elevated readings
for 2 weeks
• Past Medical History (PMH) …has had DM II for 6 years, HTN
for 10 years
• Drug History (DH) …currently taking metformin 1000mg BID, HCTZ
25mg daily
•
 Objective

Observable/factual information obtained from or

verified by a healthcare provider
• Vital signs (BP, HR, RR, temp, wt, ht)
• Physical Exam
• Labs (blood tests, urine tests, microbiology, etc)
• Diagnostic tests (x-rays, CT/MRI, EKG, EEG)
 Assessment

Your clinical judgment of the patient’s

drug-related problems

• Problem list (numbered)

• – diagnosis or impression of problem
 Plan

Specific solution for each problem outlined in

the assessment
• Numbered list to match the Assessment
• Recommendations for drug dose, frequency,
duration
• Monitoring
• Follow-up
 Generally
• Subjective, Objective, Assessment, and
Plan (SOAP)
– Subjective data – what the patient says
– Objective data – measurable information
– Assessment – diagnosis or impression of problem
– Plan of action – options for treatment, medications, tests,
consults, patient education, follow-up
 Apply your knowledge-1

• Differentiate the following patient scenario under subjective,

objective, assessment & plan ?
1. Pulse 136, regular, BP 146/88, temperature 39°C, respirations 26,

shallow and labored.(assertive)

2. Recommendation is to delivery oxygen therapy via a
nasal cannula delivering six liters per minute at 100%
Fi02.(plan)
3. chaltu, a 26 year old female. Admitted to the emergency room with acute
onset of shortness of breath. Patient is alert and somewhat anxious; she is
seen in the emergency room.(subjective)
4. Breath sounds decreased throughout with wheezing superimposed over a
prolonged expiratory phase. Patient has a dry nonproductive cough and
nasal congestion and the dx pneumonia / bronchial asthma(objective)
 Rules for Appropriate Documentation

• All entries should be legible and written in permanent ink.

• The date, time, and patient’s name should be listed on each
page of the record.
• Entries should be sequential and conclude with the provider’s
signature.
• Documentation should be completed as soon as possible.
• The record should never be altered by using correction fluid or
similar implements. If an error is made, the erroneous portion
of the entry should be bracketed and a single line drawn
through it.
• during documentation avoid incorrect use of abbreviations &
terminology.
• Developing patient education materials, news
letters, etc
• Tell me some methods of patient education?
• There are many ways to teach patients and families, including:
 verbal communication and counseling with individuals and
groups
 facilitating discussions among patients and families
 demonstrating and guiding hands‐on practice
 using educational materials
• The best form of health education is always a two-way
conversation between the patient and the health professional
but Verbal education alone is usually inadequate in teaching
patients because they may forget or misunderstand much of
what is discussed. So reinforcing verbal teaching with other
methods, such as using educational materials, patient
education is more effective.
• Many types of educational materials can be used to support
teaching, including:
 printed materials
 Audiotape, videotape and DVD
 Pictures and posters
 Models
 Computer programs
 Benefits of patient education materials

• Some advantages of patient education materials include:

• Promoting learning and increasing knowledge
• Promoting decision-making and self-management.
• Providing consistent information
• Increasing patient satisfaction
• Saving health care providers’ time.
 Preparation of PEM
To develop patient education materials, it is helpful to know
about:
 the health literacy level
 assessing the suitability of materials for patient education
 writing health information in plain language
 designing materials that are easy to read
• Health literacy is “the ability to understand and use reading,
writing, speaking and other forms of communication in health.
• Illiterate
• Literate
• Plain language is a way of writing information so that it is easy
for people to read, understand, and use.
• In health care, plain language can help all people understand
health information, but it is most helpful for those who do not
read well
 Plain language techniques

• Use common words and phrases. Avoid using

jargon.
• Provide a definition for medical terms that
patients need to know.
• Be consistent with the terms you use.
• Use numerals instead of writing out numbers.
Be specific. Avoid words that need
interpretation.
• Keep the average sentence length about 10
to 15 words.
• Runny nose ( excess mucus)
• Pain killer ( analgesic)
• Doctor (physician)
• Send you to another doctor ( referral)
• Swelling (inflammation)
• antacid ---stomach medicine
• antibiotics ---medicines that kill germs
Which one is more expressed in plain language
• Anaemia not enough red blood cells in the blood.
• Anemia occurs when the hemoglobin concentration is less than
12gm/dl
 Write in plain language
• From one hundred seventy four prescription reviews
performed, only three resulted no changes.
 Clear design

• Clear design refers to the layout or the way you put words on paper
or a web page.
• The design features for education materials are deliberately chosen
to make the information look attractive, simple and easy to read.
Writing to educate looks different than writing to market a product
or entertain a reader. Color and graphic elements are not decorative;
they are used to help explain the text. Clear design is simple, well
organized, and consistent throughout the material.
 Clear design techniques

• Choose a simple font that is easy to see and

read.
• Use no more than 2 fonts.
• Use larger font sizes for subheadings and
headings.
• Use upper and lower case letters.
• Use a line length of about 75 to 100 characters.
• Use left justification.
• Preparing a patient case presentation & Journal
presentation
 6.3.Preparing a patient case presentation

• A case presentation is a type of formal exchange between an

attending doctor or pharmacists and their colleagues.
• A case presentation delivers specific pieces of information
about a particular patient and is an important component in
ensuring consistency and standards in health care.
• Case presentations are made for new patients, follow-up cases,
and at bedside.
6.5. Journal Club Presentations
• A journal club is a group of individuals who meet regularly to
critically evaluate recent articles in the academic literature.
• To increase awareness of the current literature in a specialty.
The end!

Thank you